Objective To summarize the research progress of gene-based therapeutic angiogenesis in lower limb ischemia, so as to provide a new method for non-invasive treatment of lower limb ischemia. Method The literatures on studies of gene-based therapeutic angiogenesis in lower limb ischemia in recent years were read and reviewed. Results The incidence of peripheral arterial disease had been increasing annually. How to effectively reduce the amputation rate and mortality rate of patients with critical limb ischemia was still a clinical problem that needs to be solved urgently. A large number of basic and clinical studies had shown that gene-based therapeutic angiogenesis could effectively induce angiogenesis and collateral circulation in ischemic tissue of lower limb, leading to the significant improvements of blood perfusion in ischemic areas. Additionally, the construction of many kinds of new non-viral gene delivery vectors could also improve the safety and effectiveness of gene therapy to a certain extent. Conclusion Although promising therapeutic effect of gene-based therapeutic angiogenesis brings new ideas and strategies for the treatment of lower limb ischemia, issues still exist that have not been solved.
ObjectiveTo investigate the risk factors of carotid endarterectomy.MethodThe literatures about carotid artery stenosis in the past 30 years were screened through literature retrieval, and the study of surgical risk factors related to carotid artery stenosis were reviewed.ResultsThere were many risk factors associated with the carotid endarterectomy, including demographic, underlying disease, surgical factors, perioperative management, and so on. However, the risk factors analysis were not comprehensive enough in the current study, so there was still lack of effective methods to predict the surgical risk of carotid artery stenosis.ConclusionTo fully understand the risk factors of carotid endarterectomy and to establish a multi-factor prediction model is the direction of further research.
Objective To probe the repair method and effect of freesegmented-fibula transplantation to treat chronic osteomyelitis complicated by long bone defect in tibia in the first intention. Methods From March 1996 to December 2003, 67 cases of chronic osteomyelitis complicated by long bone defect were reconstructed with vascularized fibula graft after the long inflammable bone and soft tissue focus were resected. Their age ranged from 8 to 42 years. The course of disease was 6 months to 8 years. There were 14 cases of hematogenous osteomyelitis and 53 cases of traumatic osteomyelitis. Of them, 18 cases complicated by fracture of fibula; 21 cases by defect of skin ( 2 cm×4 cm-4 cm×10 cm) and bone exposure;53 cases by pathological fracture and nonunion; and 46 cases by 1-3 fistula of osteomyelitis. The length of bone defect was from 8 cm to 22 cm(mean 12 cm), andthegermiculture results of all cases were positive. Forty-six cases were treated with vascularized fibula graft, the other 21 cases with the skin flap. The segmentedfibula was 10-28 cm, skin flap size was 4 cm×7 cm6 cm×12 cm. Results After a follow-up of 12-45 months, the healing rate of sinus was 93.5% while the 6.5% remainders healed by the second sinus cleaning-up. The graft bone healed after 4-6 months(mean 4.2 months) by X-ray examination. The limb inflammation was controlled after 2 weeks.All 21 skin flaps all survived and the function recovery of affectedlimb was 79% of normal limbs according to Enneking evaluation system, but 2 patients occurred secondary fracture. The act or process of augmenting of tibia under 18-year-old cases were sooner than those who were more than 18-year-old. Conclusion It is a choice to repair the chronic osteomyelitis complicated by longbone defect with vascularized fibula graft in the first intention. The operation to reconstruct long bone defect is a good method to control inflammation efficiently, shorten period of treatment and reduce the time of operation.
The International Society on Thrombosis and Hemostasis (ISTH) recently released the first ISTH guideline for antithrombotic treatment of COVID-19, which provides recommendations on anticoagulant and antiplatelet agents for patients with COVID-19 in different clinical settings. The target audience includes clinicians in internal medicine, intensive care, infectious diseases, hematology, vascular medicine, residents, family physicians, and other health care providers providing inpatient or outpatient care to COVID-19 patients. This article interprets the important parts of ISTH guideline.
ObjectiveTo summarize the research status and progress of interleukin-6 (IL-6) in Takayasu arteritis (TAK). MethodRecent literature published at home and abroad about the study of IL-6 in the TAK was reviewed and analyzed. ResultsIL-6 was a pro-inflammatory cytokine secreted by a variety of cells, which participated in a variety of inflammatory and immune reactions, and played an important role in the progress of TAK. The expression levels of IL-6 in the peripheral blood and vascular wall tissues of patients with TAK were increased. The gene polymorphism of IL-6 might be related to the occurrence of TAK. Tocilizumab, an IL-6 receptor antagonist, was effective and safe in the treatment of TAK. ConclusionsIL-6 can be used as one of the monitoring indicators for the active phase and recurrence of TAK. IL-6 receptor antagonist can be used as the treatment choice of TAK, but the application results in different stages of TAK are still worth expecting.
Objective To explore the effect of long non-coding RNA H19 (lncRNA H19) on chronic heart failure (CHF) rats and its possible mechanism. Methods CHF (SD male rats, with a weight of 300±10 g, 10 weeks old) rat model was established by abdominal aortic coarctation. The 84 rats successfully modeled were randomly divided into a model group, a si-NC group [transfected lncRNA H19 small interfering RNA (siRNA) negative control], a si-H19 group (transfected lncRNA H19 siRNA), a si-miR-NC group [transfected microRNA-214 (miR-214) siRNA negative control], a si-miR-214 group (transfected miR-214 siRNA), a si-H19+si-miR-NC group (co-transfected lncRNA H19 siRNA and miR-214 siRNA negative control), and a si-H19+si-miR-214 group (co-transfected lncRNA H19 siRNA and miR-214 siRNA), 12 rats in each group. Another 12 rats were set up in a sham operation group (rats were only threaded without ligation, and the other operations were the same as the model group). After 4 weeks of intervention, the cardiac function, serum myocardial injury markers, heart failure markers, inflammatory related factors, apoptosis related factors and myocardial histopathological changes were compared. The expressions of lncRNA H19 and miR-214 in myocardial tissue were detected by real-time fluorescence quantitative PCR, and the targeting relationship between lncRNA H19 and miR-214 was detected by double luciferase reporter gene. Results Compared with those in the sham operation group, the myocardium of rats in the model group was severely damaged and a large number of inflammatory cells infiltrated; the lncRNA H19, cardiac function indexes (left ventricular end systolic diameter, left ventricular end diastolic diameter), serum myocardial injury markers (creatine kinase MB, cardiac troponin I), heart failure markers (brain natriuretic peptide, N-terminal pro brain natriuretic peptide), inflammatory related factors (interleukin-1β, interleukin-18, tumor necrosis factor-α, interleukin-6), cardiomyocyte apoptosis rate, apoptosis related proteins [B lymphocytoma-2 (Bcl-2), Bcl-2 related X protein (Bax), cysteinyl aspartate specific proteinase-1 (Caspase-1)] in the myocardial tissue of the model group were significantly increased (P<0.05); miR-214 of myocardial tissue, cardiac function indexes (left ventricular ejection fraction, left ventricular fractional shortening) and Bcl-2/Bax ratio were significantly decreased (P<0.05). Compared with the model group, silencing lncRNA H19 could significantly improve the cardiac function and the changes of the above indexes in CHF rats, and reduce myocardial injury (P<0.05); down-regulation of miR-214 could significantly reverse the protective effect of si-H19 on myocardial injury in CHF rats (P<0.05). Conclusion Silencing lncRNA H19 can up-regulate the expression of miR-214, inhibit the expression of Caspase-1, inhibit the apoptosis and inflammatory reaction of cardiomyocytes, and alleviate myocardial injury in rats with CHF.
The incidence of venous thromboembolism (VTE) is relatively high in the elderly population, and the disability, mortality, and medical expenses caused by VTE are also high. However, in a large number of randomized controlled and non-randomized controlled studies related to VTE, sufficient attention has not been paid to the elderly population with multiple underlying diseases. Therefore, the vast majority of research results recommended by VTE guidelines come from younger patients and healthy elderly people, at the same time, most relevant VTE prevention and treatment guidelines or consensus are formulated for hospitalized patients, and for non-hospital elderly populations such as home and elderly care institutions that truly need attention and risk of VTE, their recommended opinions are uncertain. In this context, the Peripheral Vascular Disease Management Branch of the Chinese Geriatrics Society has developed a consensus among Chinese experts on the prevention and treatment of VET in the elderly, based on evidence-based evidence such as domestic and foreign guidelines and relevant research.
The incidence of chronic venous disease (CVD) is significantly higher in the elderly population compared to non-elderly individuals, with more severe disease manifestations. Additionally, elderly CVD patients often have comorbid conditions such as cardiovascular diseases, making the evaluation process more complex and increasing treatment difficulty. Currently, there are no established recommendations in China for the diagnosis and treatment of CVD in individuals aged 60 and above. Against this backdrop, the Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society has developed the Chinese Expert Consensus on the Diagnosis and Treatment of Chronic Venous Disease in the Elderly based on domestic and international guidelines, relevant evidence-based medical research, and the physiological and clinical characteristics of the elderly population in China. This consensus aims to provide an important reference for improving the diagnosis and treatment of CVD in elderly patients in China.
ObjectiveTo compare the effectiveness of calcium phosphate cement (CPC) loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with CPC loaded with antibiotic versus CPC loaded with antibiotic alone in one stage for chronic osteomyelitis with bone defect.MethodsA single-blind prospective randomized controlled clinical trial was conducted. Between April 2018 and April 2019, 80 patients of chronic osteomyelitis with bone defect in accordance with the random number table were randomly divided into two groups, 40 in the trial group (CPC loaded with rhBMP-2 combined with CPC loaded with antibiotic) and 40 in the control group (CPC loaded with antibiotic). There was no significant difference in gender, age, disease duration, lesion, and preoperative white blood cells (WBC) count, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the two groups (P>0.05). All patients were implanted the corresponding CPC and external fixator after lesion clearance in the two groups. The postoperative WBC count, platelet count, ESR, CRP, hospital stay, cure rate of osteomyelitis, repaired bone defect volume, the time of external fixator removal, and the time of full weight-bearing of the affected limb were compared between the two groups.ResultsAll patients were followed up 12-24 months, with an average of 18.4 months. There was no significant difference in WBC count, platelet count, ESR, and CRP between the two groups at 4 weeks after operation (P>0.05). There were significant differences in WBC count, platelet count, and CRP in the two groups between 1 week before operation and 4 weeks after operation (P<0.05). And the ESR showed no significant difference between pre- and post-operation in the two groups (P>0.05). In the trial group, the anaphylactic exudate occurred in 1 patient with tibial osteomyelitis and the incision healed after oral administration of loratadine. The incisions of other patients healed by first intention in the two groups. One case of distal tibial osteomyelitis recurred in each group, and 1 case of humeral osteomyelitis recurred in the control group. The cure rates of osteomyelitis were 97.5% (39/40) in the trial group and 95% (38/40) in the control group, showing no significant difference between the two groups (χ2=0.000, P=1.000). There was no significant difference in the repaired bone defect volume and hospital stay between the two groups (P>0.05). X-ray film and CT showed that the bone defects were repaired in the two groups. The time of external fixator removal and the time of full weight-bearing of the affected limb were significantly shorter in the trial group than in the control group (P<0.05).ConclusionApplication of CPC loaded with rhBMP-2 and antibiotic in one stage is effective for the chronic osteomyelitis with bone defect, which can accelerate the bone regeneration in situ to repair bone defect, reduce the trauma, shorten the course of treatment, and obtain good function of the affected limb.
Objective To investigate the clinical characteristics and risk factors of immature hematomas in patients with primary intracerebral hemorrhage. Methods Patients with primary intracerebral hemorrhage who admitted in West China Hospital of Sichuan University between March 2012 and January 2021 were retrospectively analyzed. Brain CT scan was used to evaluate the presence of immature hematomas, as well as hematoma volume and the morphological features such as the number of hematoma projections or satellite foci, and finger-like projections. Imaging markers of cerebral small vessel disease such as lacunes, microbleeds, white matter hyperintensities (WMH), and enlarged perivascular space were evaluated on MRI. Mature hematomas were defined when the hematomas were completely homogeneous, without any irregularity or hypodensity, otherwise the hematomas were regarded as immature. Patients were divided into two groups: mature hematomas and immature hematomas. Multivariate Logistic regression was used to analyze the risk factors of immature hematomas. Results A total of 170 patients were included. Among them, there were 121 males (71.2%). The average age was (60.9±13.3) years old, and 129 cases (75.9%) had immature hematomas. The comparison between the mature hematomas group and the immature hematomas group showed that higher admission National Institutes of Health Stroke Scale score, larger hematoma volume, hematoma volume >30 mL, more hematoma projections or satellite foci, lower incidence of round or oval hematomas, cerebral small vessel disease score, lower WMH burden, and lower burden of cerebral small vessel disease were associated with the occurrence of immature hematomas. The results of multiple logistic regression analysis showed that lower incidence of round or oval hematomas, lower incidence of WMH, and lower periventricular WMH scores were associated with the occurrence of immature hematomas after adjusting for age, gender, hypertension, diabetes, smoking, alcohol consumption, admission National Institutes of Health Stroke Scale score, and hematoma volume. Conclusion Lower incidence of round or oval hematomas and lower periventricular WMH burden are associated with immature hematomas.